INTRODUCTION
Driven by the influence of social media, widespread availability of at-home nail kits, and easily accessible tutorials, the popularity of gel and acrylic nail polishes has surged making these stylish and long-lasting manicures more attainable than ever.1,2 However, this increased accessibility has also raised the risk of overuse and improper application techniques, potentially leading to the development of allergic contact dermatitis (ACD) of the nails.3 Both consumer populations and individuals working as nail artists and technicians have seen a notable increase in the incidence of this condition in recent years.4 Data collected between 2009–2018 indicated a jump in the incidence of ACD due to acrylates found in nail products from 55% between 2009–2013 to 79% between 2014–2018.5
Due to suboptimal appearance and associated emotional distress, individuals may fall into a detrimental cycle of repeatedly applying various nail polishes to conceal damage, further exacerbating their condition. Patients seeking medical advice may present with severe nail damage, often a secondary result of allergic contact dermatitis, which can be mistaken for psoriatic nail dystrophy. This phenomenon is known as pseudo-psoriatic nail dystrophy (PPND).6,7
Clinicians may often find it challenging to distinguish between the clinical manifestations of ACD of the nail and psoriatic nail dystrophy, as ACD can also cause features classically associated with psoriatic nail dystrophy. These characteristics include subungual hyperkeratosis, generalized discoloration in yellow and brown hues, and onycholysis (Table 1).8,9 Psoriatic nail changes commonly involve deep pitting, affecting approximately 68% of patients with psoriatic nail alterations.10 The severity and duration of a patient's psoriasis correlate with the extent of nail pitting they experience, with the depth of these pits often indicating the duration of psoriasis flare-ups. Although pitting itself is not pathognomonic for psoriasis, clinicians can distinguish it from nail disorders like PPND by examining the depth and number of pits present across all affected nails. Other psoriatic nail changes include onycholysis, subungual hyperkeratosis, and discoloration described as "oil drops" or "salmon patches."11,12 Notably, only oil drop/salmon patch discoloration is pathognomonic of psoriatic nail dystrophy, attributed to parakeratosis of psoriatic plaques on the nail bed.10 Absence of this distinct discoloration may lead to misdiagnosis and inappropriate treatment, including confusion with ACD.
The primary allergens in gel nail polish often consist of methacrylates, as formaldehyde is now less commonly used.13,14 Proper curing of gel polish with low-intensity UV light is crucial for acrylate polymerization, reducing the risk of an allergic response. However, incomplete curing may result in unpolymerized acrylates, substantially increasing the likelihood
Due to suboptimal appearance and associated emotional distress, individuals may fall into a detrimental cycle of repeatedly applying various nail polishes to conceal damage, further exacerbating their condition. Patients seeking medical advice may present with severe nail damage, often a secondary result of allergic contact dermatitis, which can be mistaken for psoriatic nail dystrophy. This phenomenon is known as pseudo-psoriatic nail dystrophy (PPND).6,7
Clinicians may often find it challenging to distinguish between the clinical manifestations of ACD of the nail and psoriatic nail dystrophy, as ACD can also cause features classically associated with psoriatic nail dystrophy. These characteristics include subungual hyperkeratosis, generalized discoloration in yellow and brown hues, and onycholysis (Table 1).8,9 Psoriatic nail changes commonly involve deep pitting, affecting approximately 68% of patients with psoriatic nail alterations.10 The severity and duration of a patient's psoriasis correlate with the extent of nail pitting they experience, with the depth of these pits often indicating the duration of psoriasis flare-ups. Although pitting itself is not pathognomonic for psoriasis, clinicians can distinguish it from nail disorders like PPND by examining the depth and number of pits present across all affected nails. Other psoriatic nail changes include onycholysis, subungual hyperkeratosis, and discoloration described as "oil drops" or "salmon patches."11,12 Notably, only oil drop/salmon patch discoloration is pathognomonic of psoriatic nail dystrophy, attributed to parakeratosis of psoriatic plaques on the nail bed.10 Absence of this distinct discoloration may lead to misdiagnosis and inappropriate treatment, including confusion with ACD.
The primary allergens in gel nail polish often consist of methacrylates, as formaldehyde is now less commonly used.13,14 Proper curing of gel polish with low-intensity UV light is crucial for acrylate polymerization, reducing the risk of an allergic response. However, incomplete curing may result in unpolymerized acrylates, substantially increasing the likelihood
